“We receive close to 20 patients daily”

Dr. R. A. Lawal , Consultant Psychiatrist, Psychiatric Hospital, Yaba, Lagos

–Dr R.A. Lawal, Consultant Psychiatrist, Psychiatric Hospital, Yaba
By Chidiebere Onyemaizu
A recent report indicate that there is an increase in the number of people with mental health disorder who visit psychiatric hospitals. What is responsible for this?
Yes. What you just said is a statement of fact. There is an increase in the number of Nigerians with mental health disorder who visit psychiatric hospitals. But this does not necessarily translate into an increase in the mental health disorder in the country. A standard scientific study is required to confirm the observation, before a definite conclusion is reached. But yes, there is an increase in patronage of psychiatric hospitals. Here, we receive close to 20 patients daily. There are factors responsible for this.
What are these factors?
For example, awareness. Nigerians are now becoming aware of where to take their relatives with mental health disorder. Our people are now moving away from traditional way of treating mental illness to western medicine. People are now more educated and enlightened. And also, don’t forget there is an increase in the country’s population, so you can not expect the number of people who patronise psychiatric hospital, say 15-20 years ago to remain the same now.
What are the factors that are responsible for mental health disorder?
Psychiatric problem or mental health disorder is a factor of the environment. It is a factor of the individual’s interaction with the environment.
Could you please explain what you mean by this?
There are many things in the environment that can predispose an individual into suffering mental health disorder. I give you an example: brain damage. When somebody suffers motor accident and suffers brain damage, he/she in likely to suffer mental disorder. And, of course, mental illness is essentially about mal-functioning of the brain, something that leads to the mal-functioning of the brain. Also, illnesses like malaria can also cause mental disorder.
Ordinary malaria?
Yes. Malaria is one of the factors responsible for mental illness. Pneumonia can also cause mental illness.
That is, when they are not treated over time?
No, not when they are not treated over time. Malaria in its acute form can cause mental illness. But, of course, as soon as the malaria or pneumonia is treated, the mental illness stops. Some other things responsible for mental illness is hereditary, that is familiar predispositions. Also, when some one undergoes a traumatic experience, like loss of job, loss of a loved one, and even women losing their jewelries. Poor nutrition over time can also cause mental illness. Metabolic disorder in children is also responsible, and of course HIV/AIDS. Drug abuse is also a factor.
How does HIV/AIDS cause mental illness?
It causes mental illness in various ways. One, when the HIV virus attacks the brain cells, it can lead to mental disorder. Also, someone getting to know that he is HIV-positive may also tend to cause psychiatric problem for the person. Even drugs used in controlling the disease, as a side-effect can also cause psychiatric problem.
Are mental illnesses or disorders permanently treated?
You need to understand the concept of orthodox medical treatment. In orthodox medical treatment– that is conventional medical treatment– there are various ways of treatment. Some are curative, like you have appendicitis and the doctor carries out a surgical operation and removes it and you are cured. Or you have malaria and you take treatment and gets well until another attack. There are, however, some other health conditions that are not cured completely, but are managed. One good example of that is hypertension. Hypertension is managed, it is not cured completely, so, the same thing goes for psychiatric disorders. Some you can cure. Some of them, we take care, and manage them and they get cured. And they remain well until may be something happens and they relapse. There are also others that are progressive and run a very long course. For those ones, we manage them like other medical practitioners manage diabetic or hypertensive patients.
Do people just walk in here themselves and say “doctor can you please take me through routine medical check-up to determine the state of my mental health”?
Well, when I started work here many years ago, you cannot just walk in and say ‘doctor please I need treatment because I lost my senses’ or ‘I want you to treat my brother or sister’. We used to operate like a tertiary institution back then. But over time, due to awareness, all that have changed. People now walk in to say, ‘I have so and so problem or my brother, sister have so and so problem’. Be that as it may, many people, however, still have the erroneous impression that anybody who walks in here is a mad person.
What is the hospital doing to fight the stigmatization of those with mental problem?
We have done a lot. One of things we have done is to make the hospital community more accessible to individuals. We do community educational awareness in the media. We go to schools, markets, et cetera, to educate them on psychiatric disorders. We do write-ups, handbills, we organise seminars, et cetera, we invite people to come to the hospital environment. Many actually think the moment they step into the hospital, they will be attacked, but as we will always say, insanity starts out there and ends here (in the psychiatric hospital).
How do you cope with patients who are abandoned by their relatives who brought them in the first place? How do you take care of such cases?
Such cases are rampant here. We have patients who have been with us here for upward of 20 years, abandoned by their relations and families.
And they are still here?
Yes. They are still on admission with us here. Some people give wrong addresses and as soon they bring the patients, they run away. And even those who supply correct addresses, as soon as the patient is brought here, they (the relations of the patient) move away from such addresses. But we work hard through our social welfare department to locate such people.